不同表面麻醉方法用于纤维支气管镜引导清醒气管插管的效果观察

目的 观察有创和无创两种表面麻醉用于经鼻纤维支气管镜（FOB）引导清醒气管插管的临床效果.方法 择期手术困难气道需清醒插管患者30例,随机均分为2组,分别采用2％利多卡因行鼻咽表面麻醉＋纤支镜喷洒气道表面麻醉（Ⅰ组）和2％利多卡因行鼻咽表面麻醉＋环甲膜穿刺气管内表面麻醉（Ⅱ组）.记录入室后5 min（基础值,T0）、环甲膜穿刺注入局麻药或经FOB气管内喷洒局麻药（T1）、FOB过声门确认气管隆突位置（T2）、气管导管进入气管（T3）、插管完成1min （T4）、插管完成3 min （T5）时患者的反应、血流动力学的变化及患者评价.结果 Ⅰ组患者HR、MAP在T3时间点较T0时间点有显著增高（P=0.009,P=0.027）,Ⅱ组HR、MAP在T1、T2、T3、T4时间点较T0时间点均有显著增高（P＜0.05）;两组间,Ⅱ组HR在T1、T2、T3、T4时间点较Ⅰ组显著增高（P＜0.05）,Ⅱ组MAP在T1、T3、时间点较Ⅰ组显著增高（P＜0.05）;Ⅰ组呛咳明显少于Ⅱ组（P＜0.05）;患者评价Ⅰ组好于Ⅱ组（P＜0.05）.结论 2％利多卡因行鼻咽表面麻醉＋纤支镜喷洒气道可为经鼻FOB清醒插管提供充分的表面麻醉,血流动力学稳定,且更安全舒适,可以推广使用.

The Effect Observation of Two Different Surface Anesthesia Methods for Conscious Endotracheal Intubation with Fiber Bronchoscope

Objctive To observe the clinical effect of two surface anesthesia method （invasive and noninvasive） for transnasal conscious endotracheal intubation with fiber bronchoscope （FOB）.Methods 30 cases of selective operation patients with difficulty airway who needed conscious intubation,were randomly divided into two groups：group Ⅰ and group Ⅱ.Patients in group Ⅰ were given urface anesthesia on nasopharynx with 2％ lidocaine and surface anesthesia on intratracheal by fiberbronchoscope sprayed,and patients in group Ⅱ were given surface anesthesia on nasopharynx with 2％ lidocaine and surface anesthesia on intratracheal by needle cricothyroidotomy.Meanwhile,we recorded the reaction,the change of hemodynamic and the asseeement of patients at the time of 5 min after entered operating room （basic values,the T0）,needle cricothyroidotomy injected local anesthetics or fiberbronchoscope sprayed local anesthetics on intratracheal （T1）,FOB passed glottis and confirmed the position of carina of trachea （T2）,tracheal catheter inserted trachea （T3）,1 min after intubation success （T4）,and 3 min after intubation success （TS）.Results The HR and MAP of patients at the time T3 were significantly higher than T0 （P=0.027） in the group Ⅰ,and the HR and MAP at the time T1,T2,T3 were significantly higher than T0 （P＜0.05） in the group Ⅱ.The HR of group Ⅱ patients at the time T1,T2,T3,T4 was significantly higher than group Ⅰ patients （P＜0.05）,the MAP of group Ⅱ patients at the time T1,T3 was significantly higher than group Ⅰ patients （P＜0.05）.The bucking of group Ⅰ patients was significantly less than group Ⅱ patients （P＜0.05）.The well assessment of group Ⅰ patients was better than group Ⅱ patients （P＜0.05） Conclusion The surface anesthesia on nasopharynx with 2％ lidocaine and surface anesthesia on intratracheal by fiberbronchoscope sprayed could provide sufficient surface anesthesia for transnasal conscious endotracheal intubation with fiber br